Ted Kennedy was dead, to begin with. There is no doubt whatever about that. We watched his funeral on television and remained watching as night approached and the picture fell into darkness. We still kept watching as the sound was cut to give the family privacy. President Barack Obama gave the eulogy wherein he said:
Ted Kennedy has gone home now, guided by his faith and by the light of those he has loved and lost. At last he is with them once more, leaving those of us who grieve his passing with the memories he gave, the good he did, the dream he kept alive, and a single, enduring image - the image of a man on a boat; white mane tousled; smiling broadly as he sails into the wind, ready for what storms may come, carrying on toward some new and wondrous place just beyond the horizon. May God Bless Ted Kennedy, and may he rest in eternal peace.
Ted Jr. told a story about his early attempt to walk up an icy hill after he lost his leg to cancer:
I started to cry and I said, `I'll never be able to climb up that hill,' And he lifted me up in his strong, gentle arms and said something I will never forget. He said, `I know you can do it. There is nothing that you can't do.'"
That night, the AP reported:
Sen. Edward M. Kennedy was laid to rest alongside slain brothers John and Robert on hallowed ground at Arlington National Cemetery on Saturday evening, celebrated for "the dream he kept alive" across the decades since their deaths.
Yes, Ted Kennedy was as dead as a door-nail.
Obama knew he was dead? Of course he did. How could it be otherwise? Yet, he evoked his name and memory often, particularly in the battle for health care reform. When he addressed a joint session of Congress on September 9, Obama reminded members that Kennedy called health care reform “that great unfinished business of our society.” Obama remembered that Kennedy had said that health care "is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."
Inspired by the life and words of Ted Kennedy, Obama said, “We did not come to fear the future. We came here to shape it,” and the people remembered Kennedy's passion and Obama’s audacity and believed him.
Oh ! But Obama also said he wanted to “replace acrimony with civility, and gridlock with progress.” That sounded good, but what did he intend to give up to get civility and progress and would it be enough?
About a month after Kennedy’s death, Obama released his own plan for health care reform. The main points of the reform package included:
1. Ending discrimination against people with pre-existing conditions.
2. Limiting premium discrimination based on gender and age.
3. Preventing insurance companies from dropping coverage when people are sick and need it most.
4. Capping out-of pocket expenses so people don’t go broke when they get sick.
5. Eliminating extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.
6. Protecting Medicare for seniors.
7. Eliminating the "donut-hole" gap in coverage for prescription drugs.
The proposal also included exchanges, individual and small business tax credits, and yes, a completely voluntary public option “to promote competition, hold insurance companies accountable and assure affordable choices.” Immediate help would come from a national high-risk pool. The plan would be cost effective, he claimed, because it would include provisions “to rein in health care costs.” Including “pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes.” Large employers would be required to cover their employees and individuals who could afford it would be required to purchase their own insurance. It was a far cry from his original proposals.
Earlier, in his presidential campaign, Candidate Barack Obama had criticized primary opponent, Hillary Clinton, for including an individual mandate in her proposed health care plan. Candidate Obama wasn’t keen on the individual mandate. The Washington Post reported on February 24, 2008:
The concept of an "individual mandate" became a lightning rod between the two yesterday. Obama said at an Ohio hospital that Clinton would "have the government force you to buy health insurance, and she said that she'd consider
'going after your wages' if you don't...."
Obama said that the key to health care reform was to make insurance affordable, “not making it "illegal" to be uninsured.” He also campaigned on something called "the public option" having signed onto a statement demanding it. He gained several supporters because of that pledge.
Ted Kennedy endorsed Obama over Clinton in the 2008 Democratic primaries. In his endorsement speech, Kennedy said of Obama:
He will be a president who refuses to be trapped in the patterns of the past. He is a leader who sees the world clearly without being cynical.
Kennedy was looking for a candidate who "refuses to be trapped in the patters of the past." Kennedy knew those patterns of the past well. He started out as an advocate of single payer health care reform. He proposed a single payer system in 1971 with no cost sharing, but President Nixon proposed his own plan that was a supposed to be a partnership between private insurers and employers. Kennedy described that partnership as one between the administration and insurance companies to provide billions of government dollars to private industry. Neither plan won over enough in Congress to become law, but Nixon effectively won that round (except for the privatization of Medicaid) as we ended up with our current employer based system with co-pays and deductibles. In 1973, Kennedy supported the HMO Act as a way to break the stalemate and an alternative to the traditional fee for service practice. The idea was to cut costs by managing care and organized the fragmented system in order to come closer to a single payer system. However, previous health care management was through not-for-profit companies, so it wasn’t yet fully understood what would happened with for profit managed care. In the ultimate bill, Congress made the mistake of allowing HMOs complete unregulated control over their policies and practices and these new privately operated HMOs turned out to be experts at denying care through required pre-certifications and outright denials. Kennedy regretted not cutting a deal with Nixon over universal health care and he was probably pretty unhappy about how the HMO and managed care takeover panned out legitimizing corporate denial of care, so he kept trying.
Kennedy first whittled away at Nixoncare in 1985 with COBRA under which he won the right of workers to continue their health care plan when they lost their jobs. The problem is that COBRA rights did nothing about cost, so as premiums grew over the years, many were priced out of COBRA.
To get more for Americans, Kennedy proposed and fought for the passage of HIPPA in 1996. HIPPA provided some portability of employer based coverage, an attempt to correct the mistakes made in 1971 and 1973, but because the insurance industry fought portability and pre-existing conditions so hard and because of required bipartisanship with republicans including Senator Nancy Kassebaum of Kansas, the whole thing was based on something new called “creditable coverage”. Creditable coverage was coverage from a prior group plan, a government run plan like Medicare or Medicaid or a state risk pool. If a person did not have past and unbroken creditable coverage, the insurer could deny pre-existing medical problems. The portability provisions ended up pretty weak and HIPPA is now mostly known as the medical privacy provisions that sometimes cause problems for families and caretakers.
Kennedy worked for expanded coverage for children with CHIP in 1997. Again, he worked with a republican, Orrin Hatch, which limited what could be accomplished and it left millions of children uninsured.
Starting in 1997, Kennedy began working for expanded coverage in his own state, but he was limited by having to work with Massachusetts’ string of republican governors. Kennedy preferred what is often called a “pay or play” employer contribution, but his goals were limited by what state republicans would accept. After several years of gridlock, a new republican governor, Mitt Romney, seemed serious about passing health care. Grabbing the opportunity to do something, Kennedy supported and worked to imprive Romney’s plan, which included both employer and individual mandates. It finally passed in 2006. Many commend Massachusetts health care for providing some basic (if expensive) coverage possibilities for people otherwise not covered. These people also support the current Senate proposal as it is similar to the Massachusetts program, but that doesn't cure the system's problems including lack of universal coverage, lack of affordability, lack of cost containment and continued reliance on employer based plans.
As noted before, Obama denounced Clinton’s 2008 for containing an individual mandate, but then, Obama picked Tom Daschle to become his Secretary of Health and Human Service. Daschle had written a book that touted an individual mandate. Daschle took his name out of the running to head off a possible unrelated scandal, and then we found out that Daschle had ties to big insurance--for some reason yet unexplained, that itself was not considered to scandalous all by itself. Daschle went, but left the individual mandate behind.
Upon President Obama’s election, it appeared that Kennedy, although ailing, would once again be working on national health care reform, Several Massachusetts doctors wrote to him reminding him that he was once a strong advocate of single payer and had previously introduced model single-payer health reform legislation. They further reminded Senator Kennedy that the Massachusetts plan, which supported private insurance and failed to control costs, plan illustrated a lot of problems:
Costs have skyrocketed -rising far faster than anticipated. Yet hundreds of thousands remain uninsured and the number of patients requiring free care has fallen by only a third. Surveys show that one of every seven Massachusetts residents still can’t afford the care they need, and among patients directly affected by the new law, more say it has hurt than helped them. We fear that worse is just around the corner; money needed to fund the reform is being drained from safety-net providers who still carry a heavy burden of care for the uninsured and underinsured.
The Senate HELP Committee bill passed just months before Kennedy’s death. It was not a single payer bill. Single payer had been taken off the table by the Obama Administration and Obama added that bipartisanship was of utmost importance. Was it even more important than the contents of the outcome? The HELP Committee bill contained health insurance exchanges, mandated coverage and eventually it added a public option. The Senate Finance Committee headed by Max Baucus made it clear that it would object to the public option. By the time the Finance Committee got underway, Kennedy was gravely ill. He died before the Finance Committee negotiations concluded.
Ted Kennedy knew that the country needed to improve its health care system and worked all his professional life to achieve it. No one can be too critical of his efforts as they were the best and most consistent that this country has had. He de jure stopped Nixoncare, but was unable to stop the employer-based system de facto. That happened in the vacuum left after the demise of both Nixon's and Kennedy's 1971 proposals. To correct the unintended consequences of that stalemate and the eventual passage of the HMO Act, Kennedy stopped trying to accomplish a complete overhaul, instead working to whittle away at the system. Continually blocked by the increasingly flush industry, supported by corporationist republicans, he kept at it and obtained coverage for children, some unemployed people and some citizens of his own state. That’s a lifetime achievement in and of itself, but it’s clear from the record that he wanted to accomplish more.
Someone once said that a person who has died is a ghost “only if someone alive is still holding on to them (sic).” Because our health care system is still so troubled, Ted Kennedy’s ghost may still walk the halls of the Capitol. Kennedy probably remains in President Obama’s thoughts as he tries to accomplish greater reform. The problems with where the long health care journey has led this young president can be summed up in several questions. How do you ever achieve true and longlasting reform in American health care when you set your sights on whittling away at the system rather than replacing it? How do you make any improvements when your attempts to whittle end up enriching the very system you seek to weaken? Will this reform create more problems than it fixes? Will unsatisfactory reform curb the public and congressional appetite for the health care reform issue? These are the same problems experienced by Ted Kennedy when he originally supported single payer and the HMO Act with only the best of intentions.
The latest status of reform is that the Senate will go on to pass another unsatisfactory compromise--continuing the "patterns of the past." President Obama has, without further examination, shut the door on single payer, drug reimportation, his campaign pledge to avoid an individual mandate, and even his most recent plan that required limiting costs and protecting coverages. The Senate deal is uncomfortably close to one Obama made with pharma and insurance in semi-secret months ago. The House has been told no changes will be welcome. As of this morning, health care reform has been put to bed. It's as unstoppable as was Barack Obama's presidential campaign when he called out Clinton for problems with her plan, but is it reform or humbug?
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